About the Stroke QUERI Center

ADDRESS: Stroke QUERI Center Roudebush VA Medical Center HSR&D 11-H Indianapolis, IN 46202 Tel: 317-988-2258 Fax: 317-988-3222 Email: lplue@iupui.edu

Roudebush VA Medical Center

The Stroke QUERI Center, under the direction of Linda S. Williams, MD, Research Coordinator and Dawn Bravata, MD, Clinical Coordinator, is located at the Roudebush Veterans Affairs Medical Center in Indianapolis, Indiana.

The Indianapolis VAMC HSR&D experience in using medical informatics to improve process and patient outcomes in primary care will be extremely valuable to the Stroke QUERI as we develop translation proposals and IIR proposals designed to improve the quality of stroke care in the VHA.

Since our initial start up date of April 1, 2004 we have made progress toward our goals and have had some notable successes.

• Collaboration with the VA EES to roll out a web based education module to inform providers about the VA/DoD clinical practice guideline for the management of stroke rehabilitation in the primary care setting.
• Collaboration with the Office of Physical Medicine and Rehabilitation (PM&R) to perform a Geographical Information System (GIS) Gap Analysis to determine where gaps exist between the existing coordinated rehabilitation services and the patterns of incidence and prevalence in the VA enrollee population.
• Development of methods to create performance indicators to improve access to rehabilitation care.
• Development and refinement of methods to identify the proportion of patients with stroke and atrial fibrillation who are receiving anticoagulation therapy.
• The establishment of the 9 item Patient Health Questionnaire (PHQ-9) depression screen as a valid assessment tool for post stroke patients.
• Developmental planning via a VISN Implementation Grant for a system intervention to improve the proportion of veterans screened and treated for post stroke depression.
• Conduct of formative evaluation of post stroke depression treatment facilitators and barriers among stroke survivors.

In the years 2005-2006 we will continue to move toward the realization of our goals by building on the strengths of our multidisciplinary team. Specifically, we plan to:

• Continue our collaboration with OQP and PM&R on the development and evaluation of new performance indicators for stroke rehabilitation scheduled to be implemented in 2006.
• Evaluate the proportion and type of providers who accessed the VA EES course titled “Stroke Rehabilitation Clinical Guideline Independent Study” and assess the provider demographic factors and the facility characteristics associated with completing the course.
• Work locally with our Veterans Integrated Service Network (VISN) quality management leaders and clinical providers to further evaluate and understand the rates of anticoagulation use for patients with stroke and atrial fibrillation.
• Collaborate with PM&R to develop GIS Gap Analysis to profile variations in access and provision of rehabilitation services.
• Develop and test implementation strategies to improve the detection and treatment of post-stroke depression.
• Survey VISN 8 and 11 VAMC facilities to establish current practices of systematic stroke survivor and caregiver education.